Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA.
Department of Biomedical Engineering, Boston University, Boston, MA.
Spine (Phila Pa 1976). 2018 Aug 1;43(15):E877-E884. doi: 10.1097/BRS.0000000000002573.
In a treatment-control animal study expansion thoracoplasty (ET) was performed in a juvenile rabbit model of thoracic insufficiency syndrome (TIS) and benefits to thoracic development and respiratory function quantified. Rabbits treated early versus late were compared to age-matched normal and disease control rabbits through to skeletal maturity.
Evaluate (1) how ET changes the natural TIS disease trajectory and (2) how timing of ET affects changes in spine growth, lung growth, and respiratory mechanics.
Pulmonary growth potential is thought to diminish with age; thus, early therapeutic intervention may increase pulmonary growth in children with TIS. However, no direct empirical evidence exists to support this treatment paradigm.
Convex left scoliosis and resultant TIS was induced in 3-week-old rabbits via surgical rib tethering. We compare the efficacy of ET performed at 7 weeks and expanded at 11 weeks (early, n = 7) versus only at 11 weeks of age (late, n = 7) in preserving lung growth and respiratory function relative to normal (n = 8) and disease (n = 10) rabbits. Sequential computed tomography images and pulmonary function testing was performed to quantify spine curvature, lung growth, and respiratory volumes. At 28 weeks of age chest wall elastance was measured in vivo then acinar complexity analyzed histologically via radial alveolar counts.
ET performed early or late altered the predicted trajectory of spine deformity, pulmonary growth inhibition, and respiratory dysfunction seen in disease rabbits. Growth was not significantly different between early and late rabbits and post-treatment gains remained below those of age-matched normal rabbits. Chest wall elastance was impaired by ET and more so in early rabbits, there were no differences in pulmonary elastance.
ET interrupted the natural progression of deformity and pulmonary hypoplasia associated with spine curvature in disease rabbits. However, growth benefits are only seen in cases of the most severe initial deformity and must be balanced against the further impairment to chest wall function associated with repetitive surgery.
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在一项针对胸廓发育不全综合征（TIS）的幼年兔模型的治疗对照动物研究扩展胸廓成形术中（ET），评估其对胸廓发育和呼吸功能的益处。通过骨骼成熟，将早期和晚期接受治疗的兔与同龄正常和疾病对照组兔进行比较。
评估（1）ET 如何改变 TIS 疾病的自然进程，（2）ET 的时机如何影响脊柱生长、肺生长和呼吸力学的变化。
肺生长潜力被认为随年龄增长而减弱；因此，在 TIS 患儿中进行早期治疗干预可能会增加肺生长。然而，目前尚无直接的实证证据支持这种治疗模式。
通过手术肋骨固定术在 3 周龄兔中诱导左凸侧脊柱侧凸和相应的 TIS。我们比较了在 7 周龄时进行 ET 并在 11 周龄时扩张（早期，n = 7）与仅在 11 周龄时进行 ET（晚期，n = 7）在保留肺生长和呼吸功能方面相对于正常（n = 8）和疾病（n = 10）兔的疗效。通过连续 CT 图像和肺功能测试来量化脊柱曲率、肺生长和呼吸容量。在 28 周龄时，通过体内测量胸壁弹性，然后通过径向肺泡计数分析组织学上的腺泡复杂性。
早期或晚期的 ET 改变了疾病兔中脊柱畸形、肺生长抑制和呼吸功能障碍的预期轨迹。生长在早期和晚期兔之间没有显著差异，治疗后增益仍低于同龄正常兔。ET 使胸壁弹性受损，早期兔更为严重，而肺弹性无差异。
ET 中断了疾病兔中与脊柱曲率相关的畸形和肺发育不全的自然进展。然而，只有在最严重的初始畸形情况下才会看到生长获益，必须平衡与重复手术相关的对胸壁功能的进一步损害。
N/A。
